Mutilations or non-consensual “normalization” treatments?

We have been asked why OII’s Official Position on Health Care does not mention mutilations. There are many reasons for this. Most intersex activism has been focused on just denouncing surgery (basically feminizing surgery), while insisting on a gender assignment as soon as possible. However, this does not seem to have helped intersex infants and adults. As a matter of fact, we are now faced with a more pathological definition o f intersex as a genetic defect (the real goal of the new DSD terminology is to classify all intersex variations by their genetic etiology) and non-consensual treatments are more justifiable now with the new terminology of “disorders of sex development” than when intersex activism began in the United States.

Instead of insisting on a gender identity assignment as quickly as possible, OII is convinced that it would be better to inform the parents of their child’s physical difference in such a way that they will be able to make informed decisions about the real health needs of their child (and not all this focus on which gender identity is best for the child which is what we are doing now). Understanding the intersex variation and the anatomical, endocrinological and other physical differences are very important and this can be very difficult for parents who are usually not specialists in genetics or anatomy. They need help to manage the health care decisions concerning their child and understanding their child’s body is what is important – not spending weeks deciding what gender identity is most appropriate. This wastes precious time and it makes the parents feel their child is so different that they can be overwhelmed, shocked and confused.

Once the parents are able to understand the intersexed body of their child and the particular intersex variation , that is the physical state of their child, it is important to stress to the parents that from a psychological and socio-cultural perspective, their child is like any other child. And this is why it is important that doctors be given the freedom to make TEMPORARY gender assignments because we do not understand the process of gender identity development and trans adults prove that we cannot predict a gender identity. The parents need support and help in understanding that a child that is classified as intersexed is not that different from other children – that intersexuality is a physical characteristic and that all children whether they are categorized as intersex or not face the same dilemma because the sex development process is so complex and there are so many factors involved that sex can never be understood clearly as a false dichotomy of just male or female. There are numerous ways that the sex of any individual could be different from just one of these categories and there will never be clear divisions between the two categories. Doctors would be more honest in stating that they are not assigning a SEX by explaining that what they are really doing is assigning a GENDER identity and the reason for this is to help the child integrate into the current socio-cultural system which is for the moment bi-gendered. This is why it is crucial that the child be allowed to be involved in the process because the point is to help the child best fit into the system and OII hopes that the system will eventually evolve to accept more gender variations and diversity.

At present, because of the way intersex children are treated, the parents are led to think that their children are very DIFFERENT from other children and that is not true. There is a physical difference and it is important to understand that in order to take care of the child’s health, but taking care of the child’s health should also include taking care of the child’s emotional well-being and in order to do that the parents should understand that psychologically and socially their child is in the same situation as all other children and that is:

there are only two genders currently accepted

there is no way to predict the gender identity of any child, intersexed or not

If one starts constantly using the word “mutilation” in such a context, this could limit the choices of the child and the parents. There are many reasons OII prefers not to use that word in the official position while leaving it to individuals affected to use that term when it applies to their own experience. Instead, we prefer the term “non-consensual ‘normalization’ treatments”.

There are operations that are necessary for the health of the child, for example when there are serious urinary problems . There are other reasons also and the parents should not be concerned so much about mutilations as normalization treatments which are not necessary for the health of the child. At each step, the parent should be free to ask if the treatment is for normalization only or for real physical health concerns.

OII was contacted by a few people who were born with cloacal exstrophy and some had photos and they felt it was irresponsible to condemn surgeries in their case.

The problem is not always the surgery itself; it is the timing of the surgeries in many cases which makes them problematic. If you make generalizations and just denounce all surgery (and for the most part the US intersex movement has basically spent most of its time denouncing only feminizing surgeries which OII has found to be no more troubling than masculinizing surgeries), this can undermine a panoply of technologies that are already available which the child could eventually have access to in order to help them affirm their own identities. There is a place for normalization treatments if desired and those should be timed so that the child and parents can help make the decisions.

This is why psychological care can be important in helping the child express their “true face” to the world and in helping the parents deal with the unknown which can be a severely traumatic shock for them.

OII works with people on all continents and we have noticed that it is principally people who live in more affluent regions who denounce “mutilations” (principally feminization surgeries). Almost all intersexed people who contact OII from less affluent regions have contacted us because they do NOT have access to treatments, surgeries and counseling.

OII also prefers the term non-consensual “normalization” treatments because:

This term includes hormone therapy and if one listens closely to those who have been subjected to hormone therapy without informed consent, it is obvious that this is just as mutilating to many of them as surgeries are to some other people.

It is very difficult to get the general public to understand that virilizing surgeries can be even more mutilating because genital mutilation has become a term too closely associated with feminist discourse and the surgeries involved in virilizing an infant are often dismissed by such discourse because of the assumption that anyone would prefer to be a male and therefore this could never be a “mutilation”. OII denounces that as sexist and very damaging to understanding the serious problem of infant virilization without consent.

OII respects our trans allies and to many of them these treatments are NOT mutilation (and they are also not perceived as mutilations by many intersex people either if they are given the right to an informed choice.)

If OII makes the same mistakes as those that have been made in the past and stresses our DIFFERENCES from others in an attempt to make clear boundaries among different identity categories (for example to find clear boundaries between trans and intersex, between homosexuality and intersex, etc), this will not bring progress. This reduces us to a rubbish heap of chromosomal, hormonal and genetic definitions (such as DSD or Disorders of Sex Development ) which do not help us understand the “true face” of a child. On the contrary, such definitions give the impression that these markers define the child and determine their future and we know that they are not reliable predictors of the child’s future.

OII is not in favor of an identity movement for people who are born with this physical difference that is another social construct called intersex. OII is an association that is in favor of human rights for those who are born with bodies that are not defined as standard for male or female and instead of emphasizing what we do not have in common with others, we wish to emphasize what we do share – our humanity and it is for this reason that we need as many allies as possible who are willing to think beyond identity politics.

OII is an organization which campaigns in favor of human rights for people born with intersex variations regardless of their identity or sexual orientation. We are not using the word “intersex” as an identity but merely as a descriptor for bodies which are not standard for male or female under current norms. The history of intersex has been one of assimilation and erasure. It is important that we speak clearly about intersex variations while taking into consideration as many different perspectives as possible from those actually affected in order to build bridges with humanity in general and avoid becoming one more invisible identity category within another minority identity movement.

People who are born with physical differences currently classified as having intersex variations are part of the WHOLE human family. OII does not wish to underline our differences from other groups, whether they be heterosexual, homosexual, trans or whatever identity because we belong to all these groups. What we wish is to build bridges between people and groups from all over the world in the hope of ending human rights violations against people with intersex variations and others who also suffer as a result of these sexist norms which affect humanity as a whole.